Why aren't permanent fillers done more often?

Dr. Rueckl doesn't recommend permanent fillers or implants. He says, "I have taken out so many problem ones over the years, I probably couldn't even begin to count. It seems like a good idea, until you realize that as your body ages naturally, your face, lips, etc. do change shape, even slightly, and putting something permanent in there does not allow the body to do this." Even though this seems like a good idea at first, your body will naturally change over the years, including your facial structure. What happens is the body contorts around the permanent filler or implant and people end up looking slightly deformed. It's much better to be able to inject fillers like Restylane and Juvederm and adjust these with more or less filler being done, as well as the placement of the filler, so you can fill different areas and spaces at different times and adjust as your body and face age.

The importance of checking your skin! Skin cancer is on the rise!

It is projected that there will be nearly 4 million new cases of non-melanoma skin cancer diagnosed this year in the U.S., which is on the rise. Additionally the incidence of melanoma in situ continues to increase with an estimated 56,000 to be newly diagnosed in 2012. To combat the damage done to your skin in your younger years and to halt the development of skin cancer, it's important to wear a daily sunscreen and use a medical grade antioxidant. Daily. Sunscreen. These two items are your primary agents in the war against skin cancer. And most importantly, check your skin regularly for any changing spots or sites, and make at least a yearly appointment with your board-certified physician. Early detection and daily sun protection are your best bet!

Whether you have a surgical procedure done (like an excision, biopsy, removal, Mohs, etc.), or you have some kind of accident, the injury to your skin can result in a scar. The best way to avoid that is to do the following:

• Clean the site several times daily using a Q-tip and 50/50 hydrogen peroxide and water. (Diluting the peroxide with water makes it less drying to the skin but still allows its cleansing attributes to work.)
• When you are cleaning, make sure the site has no dried blood or scabs, and if it does, gently remove them by soaking them in the 50/50 solution and using the Q-tip. Your body's natural healing inclination is to re-level out the skin, but in doing so, it will actually form a scar. Cleaning out the site allows only new, pink skin to fill in, rather than scabs and blood clotting, which will lead to scars.
• Every time you clean and until new, pink skin appears, apply Polysporin antibiotic ointment to the area and cover it with a bandaid. Do not use Neosporin! (40% of the population is allergic to Neosporin or will become allergic to it with regular use.) Polysporin is available on the shelf right next to Neosporin and is a better antibiotic agent. 
• Follow the above steps for about two weeks.
• If you do get a scar or redness post-healing, there is always the possibility to do a scar revision procedure or have laser genesis to the site to help improve the way it looks even more.
  
  

Xeomin (incobotulinumtoxinA) is an injectable product, like BOTOX Cosmetic or Dysport, that is used to treat glabella (frown) lines (as well as cervical dystonia and blepharospasm). It just received FDA clearance for use in the United States for glabella lines. It has been used in many European countries for years. Merz Aesthetics will begin distributing this injectable in the spring of 2012. At that time, I will be able to discuss more with you about the treatment, injection comparisons to BOTOX and Dysport, and pricing information. At this time, none of that information is available to physicians or consumers.

Rosacea is a chronic skin condition usually involving inflammation of the cheeks, nose, chin, forehead, and even eyelids. It can also persist on the neck and chest/decollete as well. It generally appears as redness, prominent spider-like veins or broken capillaries, swelling, or even eruptions similar to acne. It is exacerbated by sun, hot foods, exercise, stress, changes in temperatue, and alcohol. There is no "cure" for rosacea but there are skin treatments and some products that can help.

Most people with rosacea do not respond to topical prescription treatments (like Metrogel) and over-the-counter acne products never work. In fact, some will aggrevate the skin even more, as many rosacea patients have extremely sensitive skin. Although Dr. Rueckl does give oral antibiotics in some cases (particularly if a rosacea patient also experiences acne-like eruptions), the most important skin products to use are a gentle cleanser (like Dove or Aquanil) and a good daily sunscreen (with lots of reapplication if you are outdoors). Exfoliators and washcloths should never be used; however, the Clarisonic with a delicate head attachment is a tremendous resource because it's gentle.

The best way to manage rosacea is to get Syneron IPL/FotoFacial and Cutera Laser Genesis skin treatments to address the visible vessels and diffuse the redness of the skin. A series of five treatments will usually result in 50%-75% clearance of the vessels, flushing, and ruddiness of the skin. After that, periodic treatments every 3-6 months (depending upon intensity of rosacea) will help maintain the results and decrease any new rosacea developments. Because Syneron lasers have multiple treatment heads, our technicians have the ability to treat deeper redness and pigment, as well as surface redness and flushing. Many other lasers only have one treatment applicator, so those treatments are much more limited in results. Additionally, rosacea patients who have larger veins, usually around or across the nose or facial creases, can receive sclerotherapy injections from Dr. Rueckl, which will dissipate these veins and broken capillaries.

We have treated thousands of rosacea patients over the years and nothing compares with the outcome from laser skin treatments. If you suffer from rosacea, call to schedule an appointment with Dr. Rueckl or the technicians at The Spa at Lakes Dermatology for a free consultation to discuss your treatment options.

If you've recently spotted a new mole on your skin, the first rule is, don't panic. Many people develop moles, atypical or acquired, over their lifetimes and many of these are completely healthy. The medical term for a mole is a nevus; the plural is nevi. While it's great to check your skin thoroughly every-so-often, not every spot or mole that comes up is cancer, or melanoma. When you notice something new, employ the ABCDEs, because unsafe, cancerous, or melanoma sites tend to have:

A - asymmetry: 1/2 of the mole is unlike the other

B - border irregularity: the shape of the mole is irregular, poorly defined, or scalloped

C - color: varied from one area to another; shades of tan or brown; black; or while, red, or blue

D - diameter: greater than 6mm or is growing

E - evolving: looks different from other similar spots, or is changing in color, size, or or shape quickly

There are additional features such as bleeding, oozing, scaliness, itching, pain, and tenderness that should also be noted.

The truth of the matter is that if you notice something suspicious, you need to schedule an appointment with Dr. Rueckl or another dermatologist. The longer a site is there and is potentially dangerous, the more problematic it can be to remove it. Since the skin is the largest organ of the body, you need to protect it just as much as your heart, lungs, liver, etc. Don't worry about every little skin spot, but don't ignore suspicious sites either. Schedule an annual skin check with your dermatologist to go over any new spots or sites, and if you've had previous skin cancers in the past, increase these visits to twice yearly so anything new can be addressed quickly.

Latisse is a product made by Allergan, the same company that manufactures Botox and Juvederm. Latisse is a topical eyelash treatment that is applied daily to grow your eyelashes longer, thicker, and darker. It is the only FDA-approved and researched eyelash treatment. The effectiveness of Latisse was first discovered in people with glaucoma who were using Lumigan eyedrops (also made by Allergan). These patients saw increased eyelash growth while using Lumigan and it ignited a study by Allergan to determine how and why this was happening. Allergan was able to separate the eyelash growth component out and create Latisse, which has the active ingredients from Lumigan, but is applied differently.

Latisse works by lengthening the eyelash growth phase. Every hair follicle on your body has a growth phase, and the length of time of the phases is different for each area of the body (and it can change over your lifetime too). By increasing the growth phase, this allows the hair follicles of your eyelashes to grow for a longer period of time, thereby growing longer and thicker, and becoming darker. It also shortens the time of the other phases, allowing lashes to regrow at a quicker pace than normal. 

When applied properly (our staff all use Latisse and can go over exactly how to use it with you), Latisse will make your eyelashes grow longer, thicker, and darker. Your results will vary depending on your age and other factors, but in all studies, both those by Allergan and those done independently, there were no reported cases of non-responding. All users saw at least one of the areas increase--length, thickness, and/or darkness.

Anyone can use Latisse and the studies have been done on users as young as 20 and as old as 85. Studies have been done on various ethnicities, and both males and females. Latisse is truly an anti-aging product for anyone, and the results are unmatched by any other product on the market. Latisse is available for purchase in our office every day, so there's no need to come in for an office visit or get a prescription filled at a pharmacy. Stop by today and ask us any questions you have about Latisse!

A new term for getting dermal fillers - i.e., Restylane, Juvederm, Perlane, Radiesse and/or Botox or Dysport, is called a "liquid facelift" or "liquid lift". There is no definitive number of fillers or products specifically done that define a "liquid facelift"--each is unique. What it really means is that products ("liquid" fillers), are put under the skin to tighten, lift, smooth, volumize, and transform the look of the face, so that it looks like you got a mini facelift, but there was no cutting, downtime, or surgical procedure. In reality, this is not a new procedure, but just a new marketing term for having multiple dermal injectables done at one time. Dr. Rueckl has done dermal fillers and injectables for over 25 years and can help you determine what fillers or Botox/Dysport would be the best for your face, structure, and desired results.

Dr. Rueckl suggests a few simple things:

Make sure your skin is damp before you apply any products, including reapplication of sunscreen.

Spritz a little water on your skin, or apply products (thinnest to thickest) right after you shower. You don't want to apply products to dry skin for several reasons: 1. you will use more product than necessary, 2. your skin won't absorb the products as much because the skin is dry and your products will just sit on the surface. When your skin is wet, it's able to absorb products better, meaning you get better results and you apply less product.

Make sure your skin is clean when you apply products.

If you apply products when your skin is dirty or at night without cleaning your face, your products are just sitting on top of dirt, oil, and other icky stuff. If your skin is clean, your pores are clean and able to absorb the products better. Don't scrub your skin harshly before applying either - lightly wet your skin with your hands, or run through a cycle with the Clarisonic, which cleans your skin 6x better than manual cleaning.

Apply the recommended amount of each product, in the recommended order.

Using more product will not make them work any better, and using less will cost you more money in the long run because you're not getting the right results. Follow the instructions on the packaging and the instructions from our staff for the best use of each product.

Stick with a product for a little bit.

Products are not miracles and many of them take time to work. Results may build over time. Remember that you may have damaged your skin for years, or you may have had acne for years. You can't expect a product to work miracles and resolve all that within a few weeks. Give the product time to work and give your skin time to see results. Jumping from product to product isn't good for your skin, or your budget.

Most people use too rough of products (like exfoliaters, washcloths, and loofahs) thinking they are helping their skin get cleaner, faster. In fact, all of these products are too rough for your skin and should never, ever be used! The best things to use are either just your hands, or a Clarisonic. Your hands are soft and gentle, but some people can be too rough and scrub too hard, often leading to milia (tiny little white calcium bumps) on sensitive skin. The Clarisonic is a controlled, soft way to clean your skin, on your face and body. And with interchangeable heads specially designed even for sensitive skin and acne, these systems are the best on the market. The patented side-to-side rotations of the applicator head allow the skin to be cleansed, gently, without splashing products all around you and onto mirrors, counters, etc. The systems can be used with any cleansers (we recommend Aquanil {a soapless, lipid free cleanser for even the most sensitive skin} or Dove), but any cleanser you like (including acne cleansers!) can be used with the Clarisonic. The applicator heads cannot absorb any products or make-up. Plus, the heads last about 4-6 months with daily use, so they are very affordable. Your entire family can use one system - and each person can get their own brush head. The best thing about the Clarisonic? They have a 2 year warranty so even your tough teenagers can't ruin your investment. These systems are made to last and offer the best results for even the most sensitive skin. All of our staff members have units and have seen improved results from our products, both prescriptions and topicals, with the daily use of these systems. We love our Clarisonics! Stop by to find out why and sample one of the testers in our office.

There is a vast amount of negative press on the acne medication, Accutane. However, there are also great benefits to the drug, many that cannot be found in any other acne medication. Much of the negative press lately has to do with supposed contraindications from Accutane, including depression, tendancies toward suicide, Crohns disease, irritable bowel syndrome, and other mood alterations. The simple truth is that we have NEVER encouraged a patient to stop taking Accutane for any of these reasons. Some patients cannot handle the dryness associated with Accutane, but that is the only primary reason we have people stop taking it.

Dr. Rueckl has prescribed Accutane to tens of thousands of patients over his years in medicine, and he simply has never seen any of the contraindications that the lawsuits and fearful opposers state. Dr. Rueckl has taken the drug himself; he has prescribed it to his children, nieces, and nephews; and he believes that there is no similar drug on the market. It's truly unfortunate that Accutane gets such a bad reputation because it's a really great drug, with great benefits, and it cannot be replicated by any other medication, laser, or therapy. There are other acne medications you can take, both oral and topical, but the time they take to work can be much longer than Accutane and some actually have worse, proven side effects. Additionally, there are different types of acne and many medications simply work on only one type of acne, so you might end up with multiple types of medication if you have different types of acne.

Dr. Rueckl doesn't prescribe anything that will harm patients. He gets no compensation from, or even samples, of Accutane, so there's no monetary or office advantage for him to give it out. When he prescribes it for patients it's because it's the best thing on the market for them. If you have fears about Accutane or have heard horror stories or bad press, please call our office and we'll discuss it with you. There is no reason that you should have to live with bad acne and scarring.

Dr. Rueckl selects which filler to use primarily based on the location the filler will be injected. Some fillers, like Restylane or Perlane, have larger particle sizes, so they fill deeper lines better or plump areas like the lips better. Other fillers, like Juvederm, fill tiny marionette lines (sometimes called smoker's lines) better because the filler particles are so tightly bound together. We rarely recommend patients do Radiesse for their first filler ever and tend to only recommend that filler to patients who've tried and loved previous filler products. Additionally, Radiesse can never be placed in the lips because the compound is too firm and white and will never look soft or natural when in the lips. You can always see Dr. Rueckl before you do any fillers to discuss what's on the market, his experience, his recommendations for you, and he can answer any questions you have.

The most important thing to remember when selecting fillers is that rather than paying for the filler itself, you are really paying for the injector. Each office and injector will have different strengths and styles of injection. You need to make certain you always select a good injector (a physician!) who has a minimum of several years of injection technique and has tried lots of different fillers over the years. Dr. Rueckl has done tens of thousands of filler injections and has been doing them since before some of the products were even FDA approved. Additionally, at our office, you will always get a pre numbing lidocaine block (with epi) to cut down on any pain, bruising, and swelling. When choosing a filler, don't always shop for the cheapest price in town - the injector is more important than anything else! And, remember that some filler brands come in different syringe sizes, and different grades of the product too, so pricing can range dramatically based on that too.

According to the Skin Cancer Foundation, SPFs of at least 15 should be recommended as they prevent 93 percent of UVB from reaching the skin. SPF 30 blocks only 4 percent more UVB (97%), and those over 30 protect the skin from just a miniscule more percentage of rays. The U.S Food and Drug Administration will soon cap the SPF number at 30 because protection benefits at higher levels than 30 are negligible, while adding false confidence to the consumer of significantly higher protection. An SPF of over 30 will be noted as '30+', with no added claims for efficacy. An SPF 30 is advisable for sun-sensitive individuals, skin cancer patients,and people at high risk of developing skin cancer. They are also important for clients who are using exfoliants, such as alpha hydroxy acids, retinoids,acne products, or other medications that increase sun sensitivity, such as Accutane, antibiotics, and high blood pressure medications. Even with the ideal sunscreen, a small amount of UV rays can penetrate the skin and cause damage. For that reason, full application compliance is important for the user, after determining the time for reapplication. We have the best names in sunscreen protection. Even though sunscreens with "natural" ingredients like zinc and titanium may seem like a better option, these "natural" ingredients are still made in a lab and are therefore chemicals. Find out which sunscreens are actually better! Give us a call today at Lakes Dermatology - 702-869-6667 and we'll suggest the right preparations for your skin or treatments to correct the damage you've sustained. Help protect your skin from aging, discoloration, and wrinkles, and most importantly, skin cancer by applying sunscreen....everyday! Check out The Skin Cancer Foundation's website at www.skincancer.org to find out more about protecting yourself.

Two types of sunscreen ingredients, physical and chemical, are available to prevent UV rays from attacking the viability of healthy skin cells. A physical sunscreen is not absorbed into the skin. It physically reflects the rays away from the skin by sitting on top of the skin. The type used the longest, for over 300 years, is zinc. Zinc has not been shown to have any adverse reactions, and actually has been shown to support and promote healing of the skin. The downside to zinc-based products has been the whiteness or ashiness it produces on the skin after application. (Remember the lifeguards with white sunscreen across their noses - THAT'S how you need to use zinc sunscreens for them to work fully!) Chemical sunscreens have rapidly grown in use in the sunscreen market with the development of the revolutionary chemical avobenzone (Parsol 1789), the only FDA-approved chemical SPF ingredient for broad-spectrum protecyion against UVA and UVB. New ingredients such as octylcrylene and the benzophenones are also available to improve a sunscreen’s defenses against shorter UVA rays. Although chemical sunscreens have gotten a bad wrap for having "chemicals", remember this, the zinc in that "natural" sunscreen you're using was made in a lab, and is therefore, also a chemical!

UVB, or Ultraviolet Burning, are short wave solar rays measuring 290-320 nanometers. It stimulates the production of essential Vitamin D in our bodies. Considered the cause of sunburn, they are also thought to be the main cause of basal and squamous cell carcinomas, and to highly contribute to the cause of melanoma. UVA, or Ultraviolet Aging, are long wave solar rays of 320-400 nanometers. They are not fully blocked by the ozone layer and the remaining rays aid photosynthesis for plants and trees to process sugars for food when they extract carbon dioxide from the atmosphere. Over 90% of the rays reaching the earth from the sun are UVA. The bad news about UVA rays is that it penetrates the skin deeper than UVB and can cause damage to the collagen and elastin in the dermis. UVA causes the fine lines and wrinkles of photoaging, pigmentation marks, and in the long term, contributes to the occurrence of skin cancer, especially melanoma. While UVB does not penetrate through glass and water, UVA can, making it more dangerous. It is also present in fluorescent lighting. The highest exposure hours in the day for these rays is 10 AM-4 PM, making these the most important hours in sun exposure avoidance practices; sunscreen is a major part of a comprehensive sun protection program.